The criticism by Benson and colleagues that cognitive behavioral therapies should not be critically assessed in isolation misses the point of our analysis [1]. Every trial included in our meta-analysis explicitly sought to document the efficacy, or lack thereof, of one or more cognitive behavioral therapies in the treatment of essential hypertension while controlling for confounding variables or cointerventions.

Moreover, the references cited by Benson and colleagues relate to post hoc observations of selected subgroups of patients (for example, “responders” compared with “nonresponders”), useful only for generating hypotheses to be tested in randomized trials. For example, they cite the randomized trial by Cottier and colleagues [2] included in our meta-analysis, in which a post hoc analysis of nine patients who “responded” to cognitive therapy found them to be younger, more anxious, and exhibiting a higher resting sympathetic tone than seven nonresponders. Yet, their overall conclusion was that blood pressure responses to cognitive therapy do not exceed the placebo effect in unselected patients [2].